Colonic varices as a result of persistent mesocolon of the ascending and descending colon

Kanai, Motoshi; Tokunaga, T; Miyaji, Tsuyoshi; Mataki, Norikazu; Okada, Chisa; Mitani, K; Aono, Shigeaki; Kobari, Shinichi; Hakozaki, Yukiya

doi:10.1055/s-0030-1256137

Cited by 10 publications

(10 citation statements)

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“…To the best of our knowledge, only three case reports have described the coexistence of persistent ascending and descending mesocolons (4,5,7). To the best of our knowledge, only three case reports have described the coexistence of persistent ascending and descending mesocolons (4,5,7).…”

Section: Discussionmentioning

confidence: 93%

“…Although Popky and Lapayowker reported that persistent descending mesocolon was much less common than persistent ascending mesocolon (1), the latter has been rarely reported. To the best of our knowledge, only three case reports have described the coexistence of persistent ascending and descending mesocolons (4,5,7). This may be because persistent ascending mesocolon is not clinically important and is only recognized when it exists with persistent descending mesocolon.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons: A case report

Hisano

Ueki

Kono

et al. 2018

Asian J Endoscop Surgery

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Persistent mesocolon is an embryological anomaly of the colon resulting from failure of the primitive dorsal mesocolon to fuse with the parietal peritoneum. We herein present a case of laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons and a right-bound inferior mesenteric artery. Preoperative 3-D CT demonstrated that the sigmoid colon had shifted to the right abdomen and was located under the ascending colon. Moreover, the inferior mesenteric artery and vein traveled toward the right abdomen accompanied by the mesentery of the descending colon. Adhesiolysis between the ascending and sigmoid colon was initially performed, and the sigmoid colon was placed in its normal position. The inferior mesenteric artery was then divided with lymph node dissection using a medial approach, and high anterior resection was completed. An understanding of the anatomical characteristics of persistent mesocolon is important to ensure safe laparoscopic surgery.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons: A case report

Hisano

Ueki

Kono

et al. 2018

Asian J Endoscop Surgery

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“…Clinical complications that have been associated with these anatomical variations include: primary intestinal obstruction [9], and colonic volvulus as a result of a persistent descending mesocolon [10]. Persistence of the mesocolon of both, ascending and descending parts of the colon, has manifested as colonic varices [11]. …”

Section: Introductionmentioning

confidence: 99%

Anal protrusion of an ileo-colic intussusception in an adult with persistent ascending and descending mesocolons: a case report

Ongom¹,

Lukande²,

Jombwe³

2013

BMC Res Notes

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BackgroundIntussusception is one of the less common causes of intestinal obstruction among adults. It is usually covert (concealed) in its clinical presentation. The ileo-colic type with accompanying anal protrusion is extremely rare. The case at hand is that of both an ileo-colic intussusception with anal protrusion, in the presence of a persistence of both the ascending and descending mesocolons; a case possibly yet to be documented in literature.Case presentationA 32 year-old African-Ugandan woman presented with complaints of a mass protruding per anus for 2 weeks. It was reducible and associated with colicky abdominal pain, loose stools, and bloody-mucoid discharge per anus. She had previously had a one and a half month’s history of abdominal pain; periodically continuous, while other times colicky in character. Examination and investigations revealed an intussusception with a partial intestinal obstruction. At laparotomy she was found to have an ileo-colic intussusception with a freely mobile colon throughout its length. There were persistent ascending and descending mesocolons, and absent hepatocolic and splenocolic ligaments. The intussusceptum was ‘milked’ but not completely reducible. A right hemicolectomy was done, with ileo-transverse colonic anastomosis. Histopathological examination revealed no preexisting pathologic lesion as a lead point.ConclusionThe persistence of the ascending and descending mesocolons (azygosis) best explains the anal protrusion of an ileo-colic intussusception with partial obstruction. In this case zygosis (normal retroperitoneal ascending and descending colonic positioning) failed embryologically. This experience is particularly beneficial to general surgeons, radiologists, gastroenterologists, colorectal surgeons and pathologists.

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“…Such abnormalities have been documented in radiologic and gynecologic reports since the 1960s (2,3). However, recent publications have detailed specific clinical complications of PDM, such as primary colonic varices, intestinal obstruction, and postoperative anastomotic stenosis (4)(5)(6)(7). Since most patients with PDM are asymptomatic before surgery, surgeons are rarely able to identify PDM intraoperative.…”

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confidence: 99%

Persistent Descending Mesocolon as a Key Risk Factor in Laparoscopic Colorectal Cancer Surgery

Wang

Kondo

Hirano

et al. 2020

In Vivo

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Background: Persistent descending mesocolon (PDM) is a rare colonic anatomical variant. However, PDM's impact on the technical aspects and outcomes of laparoscopic colorectal cancer resection are unclear. Patients and Methods: This retrospective clinical cohort study was conducted at a high-volume cancer center in Japan to evaluate intra-and postoperative outcomes of laparoscopic colorectal cancer surgery in patients with (PDM+) or without (PDM-) PDM over the past 7 years. Results: Between January 2012 and September 2019, 2,775 patients underwent laparoscopic colorectal cancer resection at our center, including 60 (2.1%) cases of PDM. Preoperative detection was achieved in only 5 patients (8.3%), 39 patients were men, and 21 patients were women. The average age was 67 years. Twenty patients had a history of prior abdominal surgery (33.3%), with little or no subsequent adhesions. The average duration of sigmoidectomy in PDM+ patients (n=17; 217.7±14.2 min) was significantly longer than that in 176.2±2.4 min; p=0.003), as was average blood loss (32.3±10.6 ml vs. 16.7±2.8 ml; p=0.03). Likewise, average operative time for high anterior resection in PDM+ patients (n=11; 227.1±20.2 min) was significantly longer than that in 195.6±3.0 min; p=0.048). Rates of postoperative anastomotic leakage and postoperative recurrence did not differ in both groups. In PDM+ patients, retention of left colic artery had no impact on proximal specimen margins or occurrences of anastomotic leakage. Conclusion: PDM prolongs operative times and increases bleeding in laparoscopic colorectal cancer surgery and should be considered a risk factor when encountered.

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Colonic varices as a result of persistent mesocolon of the ascending and descending colon

Cited by 10 publications

References 1 publication

Laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons: A case report

Laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons: A case report

Anal protrusion of an ileo-colic intussusception in an adult with persistent ascending and descending mesocolons: a case report

Persistent Descending Mesocolon as a Key Risk Factor in Laparoscopic Colorectal Cancer Surgery

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